TREATMENT OF HEPATIC HYDATID CYST
Keywords:
HYDATID CYST, LIVER SURGERY, BILIARY COMMUNICATIONAbstract
Hydatid cysts of the liver are benign lesions which require a wide range of surgical strategies for their treatment. The complex treatment of the hepatic echinococcosis has made great progress to less invasive therapy for this category of patients. The multimodal therapy is represented by administration of antiparasitic agents, interventional radiology, interventional endoscopy, eco- or CT-guided puncture, laparoscopy and associations between those. There are still difficulties in the treatment of complex echinococcosis, especially of the cases with one or more complications. Material and methods: We analyzed retrospectively a group of 74 patients who underwent surgery for complex hydatid cysts over several years at General Second Surgical Clinic, Iasi, Romania, between 2005-2021, in order to determine the evolution of the surgical treatment. We recorded the following parameters: age, gender, place of origin, serological and paraclinical investigations relevant to liver function and Echinococcus granulosus infection, affected hepatic segment, surgical technique, postoperative evolution and days of hospitalization, complications, recurrences and chemotherapy. Results: From the total number of patients admitted in our clinic diagnosed with hepatic hydatid cyst, only 30.7 % had surgical indication. We performed the surgical treatment of the hydatid cyst by laparoscopic approach in 35.1% of cases and a classic approach 56.8%. The surgical technique used in the most cases was partial peri cystectomy (n=54, 73%), total cysto-peri cystectomy in 8.1 % of cases (n=6), and simple drainage of the remaining cavity after the inactivation of the parasite, in the rest of the cases (n=14, 18.9%). The post-operative biliary fistula was encountered in 19 cases (28.4%), with no significant correlation between the surgical approach and the apparition of biliary fistula, the percentage being similar in laparotomy and laparoscopy, with only a 3% difference towards the laparotomy. Conclusions: The biliary fistula remains rather frequent complication of the hepatic hydatic cyst and it’s a challenge to predict the apparition of this complication.
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